Dissecting the Follow-Up Study
by CSMESS “Thoracoscopic Sympathectomy is recognized as an effective treatment for patients with severe hyperhidrosis…we reviewed our results in patients were at least one year from surgery… 121 patients were identified… Patient-perceived effectiveness of the procedure vary depending on the level of Sympathectomy: T2-50% face/scalp in this study effective, T3-95.6% palmar in this study, T4-100% axillary in this study… Patients with T2 were significantly more likely to have severe compensatory sweating than those with other levels. Patients with levels other than T2 with T3 or T4 sympathectomyreported high degrees of satisfaction irrespective of postoperative compensatory sweating. Patient satisfaction and perceived effectiveness with Sympathectomy for palmer and axillary hyperhidrosis remain high even one year after the procedure… We recommend limiting sympathectomy to either the T3 or T4 level. Note that the study only measured the nebulous "Patient-perceived effectiveness". I think it is safe to assume that, once again, the authors of the article couldn't be bothered to actually measure anything objectively or quantitatively. They performed an irreversible, destructive procedure to treat excessive sweating on 121 people and published a study without making a single measurement of perspiration. They probably didn't measure important aspects of other organs and systems that are sympathetically denerved by this procedure either. Unbelievable. Since no measurements were made, it is not possible to conclude that T2 actually resulted in more CS than T3 or T4. Could it be the T2 patients lived in hotter climates or were more physically active than the other patients? Could there have been other physiological factors present in the T2 group that caused more severe side effects? Without a doubt. But it doesn't appear that factors other than the location of surgery were even considered. It's seems they have forgotten the golden rule that statistical correlation does not equal causation. Now, consider this contradictory statement: Quote: Patients with T2 were significantly more likely to have severe compensatory sweating than those with other levels. Patients with levels other than T2 with T3 or T4 sympathectomyreported high degrees of satisfaction irrespective of postoperative compensatory sweating. Patient satisfaction and perceived effectiveness with Sympathectomy for palmer and axillary hyperhidrosis remain high even one year after the procedure… So, which one is it? Is satisfaction related to severity of CS or not? It says T2 patients have higher amounts of CS and it's implied that that is the reason for dissatisfaction. But, the second sentence says that T3/T4 patients were satisfied regardless of severity of CS. That implies some T3/T4 patients did get severe CS and they just tolerated it better. If so, doesn't that indicate that factors other than location influence the severity of CS? It most assuredly does. If even a single T3 or T4 patient gets severe CS, one has to admit that CS is not solely a function of surgical location. And, going back to my first point, how do you draw conclusions about CS severity when you don't have any measurements? We should also note that this is a short term study. One year is a very short period of time. The average life span is approximately 77 years now. Taking a guess that the average patient age was 27, they have merely succeeded in measuring perceived satisfaction over a period that is only 2% of the patient's remaining years on the planet. Most disappointing though is the emphasis on CS and exclusion of all other aspects of the surgery that have a negative effect on a patient's health. I'm still waiting for a study that at least acknowledges that completely eliminating the ability to perspire on regions on the body is simply unhealthy regardless of "perceived effectiveness". Finally, we should not forget that for many years similar "studies" have shown very high satisfaction rates for people who had T2 surgery. Drs. Neilson and Fischel, I'm sure, would dispute that T2 ETS results in a 50% dissatisfaction. How could these "studies" have come up with such vastly different results? These studies all have one thing in common. The assumption that severe CS is a function almost exclusively of location or technique. This is a very narrow view. So, I ask any ETS surgeon reading my diatribe that the next time you line up a group of guinea pigs for one of your vivisection programs, admit the results of sympathectomy are unhealthy regardless of the patients perceived satisfaction with the cosmetic effects over the sort term. Make some friggin' measurements and consider that, maybe, just maybe, there are a whole host of factors beyond location and technique that dictate how an individual will react to a major nerve injury. source